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When you go through ivf, you see your nurse, you see your doctor, you have the procedures, and you certainly feel every single injection, what you don’t see is the laboratory and what happens behind the scenes with your eggs to make those beautiful embryos.

Let’s have a look now.

It all starts in the operating theater where the eggs are collected. The key thing in the theater is to make sure we always have the eggs in the right condition from the very moment. They are obtained by the doctor. It’s critical that the temperature and gas exposure of the eggs is precise all the way through the process. So we use an incubator in the theater, right? Next to the patient. As you know, scientists work in a closed environment to protect the health of the eggs, from the moment they are collected. The identity of each patient’s eggs, are digitally tracked from the moment. They’re collected all the way through the laboratory. When eggs are collected, they go into a tube which has a digital chip attached. Disconnects with our electronic witnessing system which then monitors the identity, the eggs, the sperm, and the resulting embryos all the way through the process. Our embryologist has to log into the digital system before every procedure. Everything that enters into the scientists workstation has to match the ID details that have been ended into the digital system. If it doesn’t match an alarm, will go off.

Now the embryologists prepares the dish of culture media. She is ready to start receiving the fresh eggs from the nurse. The search for eggs has begun and the embryologist is going through the fluid hunting very carefully under the microscope for the first egg, As she’s examining the fluid, the embryologist counts and is allowed to let the clinician and the nursing team know how many eggs have been collected. The embryologist labels the tube with a number of eggs collected and they were put in an incubator to be kept warm. The temperature is set to 37 degrees and the eggs are placed in secure container to be transported to the laboratory. Here we are at the embryology laboratory. You know the eggs arriving from the day surgery. This particular laboratory is a clean air laboratory to protect the atmosphere of the lab. So the eggs go through an airlock. As the door on the outside of the lab closes, the embryologist in the lab will open the door and

Retrieve the eggs straight away. Always keeping them in a heated, block to stay warm. Just like the incubator in the operating theater. The workstations in the laboratory, have a carefully controlled environment to protect the health of the eggs. The first thing, the embryologist will do is confirm the number of eggs to ensure they are all accounted for now. We need to fertilize the eggs with sperm. But first, we have to prepare the sperm sample. What we need to do is make sure we are using the very best sperm. So there are a series of preparation steps that need to be done. The first one is to liquefy, the sperm by rolling it around on these tubes, as soon as the sperm enters the lamb, We then use a special solution that will separate the fast sperm from the slow, sperm called a density, gradient, and it’s put in a centrifuge When the sperm comes out of a centrifuge, there are layers. All the debris at the top, the slow sperm is halfway up and the fast sperm will go to the bottom of the tube.

After separation process, the sperm is washed and put back in the centerfuse. Then sits in room temperature to rest, the sperm for 30 minutes before the insemination of the eggs.

In the lab, we will treat some patient’s eggs with IVF. This is where the eggs and sperm placed in a dish together and allowed to join by themselves. You can see here, the egg in the center, surrounded by hundreds of thousands of moving sperm. For other patients, particularly those with sperm problems, we may need to directly inject the sperm into the eggs. The process called exit. You can see here the embryologist using the micromanipulators to line up the microscopic, capets to inject the sperm into the eggs. The embryologist little, first of all, puncture the skin of the egg head inject, the sperm directly into the middle. This process takes a huge amount of training and skill to get it right. You can also see from the equipment used that it requires some video gaming skills. Often don’t go amiss In some cases, men can have damage to their sperm cells. That mean that even though the egg is fertilized, the resulting embryo may not grow well, One approach to this is to study the sperm cells with digital high magnification His technique uses digital technology to magnify the image of the sperm to seven and a half thousand times, to see the ultrastructure of the head of the spur. This allows us to identify the sperm with the healthiest, ultrastructure. In a sperm cell. The genetic material, the dna is all situated in the head of the spur, and that’s how the study of the ultrastructure allows us to identify the healthiest sperm for injection into the egg. What we do next with eggs, depends on which procedure with use to fertilize the eggs.

If we are fertilizing, the eggs with 5f, we will keep them in small, individual incubators overnight, to allow them to fertilize first, and it’s only the next day that they go into our most advanced incubator the embryoscope. This gives the embryo time to develop to the point where the embryoscope can accurately monitor. If we’re doing exe, we have already stripped the code off the eggs so they can go into the embryoscope as soon as we have finished. The process of injecting the sperm into the egg. The embryo scope is at the heart of our laboratories. When an umbrella is developing, it’s moving its dynamic all the time.

With this technology, we can monitor the growth of an embryo, every step of the way, because the embryoscope takes a photo every 10 minutes. In this machine, we can see the live images of every area and related to the exact number of hours since insemination We can also see very clearly that one patient’s embryos may grow at different speeds and with varied success, we can watch the evolution of the embryos as the egg fertilizers and the two male and female pronuclei appear in disappear and the cells. Now start to divide firstly into four cells, then eight cells, then hundreds of cells. And of course if a baby is born eventually trillions of cells The key to all of this is that for these five days, the embryos are staying in the incubator, we can study them clearly without the need to touch or handle them. The challenge is that, we have all this beautiful information of every embryo development, but how do we turn that information into a form that we can use to help our patients? We have developed our AI technology for identifying the best embryo. This AI is a highly sophisticated, artificial intelligence, deep learning system called Ivory which studies all of these images. It does this objectively and independently? Looks at each image from the embryoscope to calculate a prediction of which embryo is most likely to turn into a baby and which one isn’t Looking at these images, some of them have the potential for life and unfortunately some of them don’t The key for us is to know which one is the best one to transfer, back to the patient. Before we had ivy, the embryologist, selected embryos by eye, and they did a good job of it, but whilst it’s obvious to see a poorly developed embryo. It’s not so obvious to see the differences between too well developed members. What ivy will do is analyze all the images over the whole five days of growth to give us a much more precise guide more precise than anything we have seen before. As to the likelihood was to which embryo is likely to implant by using ivy, artificial intelligence, we can select the embryo that will give our patients a chance to get pregnant or quickly. In some cases, such as, for instance, where the couple are at higher risk of having a whole chromosome variation in their embryo. Or either partner is carrying a single gene variation that could affect the health of their child. It can be useful to study the genetic makeup of the embryo. To do this. Once the embryo has reached the blaster’s stage on day, five, a few cells are extracted from the outside of the embryo. These cells are then sent to the genetic laboratory for analysis, and the embryos are all frozen. Once the genetic test results come back, we will know which of the embryos is affected by the genetic problem, and can then decide, which embryo is safe to transfer. We will transfer the best embryo but first, what do we do with the other good embryos? We freeze them so that if either that first transfer is unsuccessful or they want to have another child in the future, the couple can use them to conceive without having to go through a whole fresh IVF cycle. Nowadays one percent of all Australians or .5 % of all US citizens born today have come out of a freezer before they were born. To freeze an embryo. We have to use specialized solutions to ensure the embryo is frozen safely and in a healthy way. We use a very rapid freezing process. That sucks all the fluid out of the embryo called vitrification. This has been the norm in most five years, laboratories for the last 10 years or so. The first step of vitrification is to put the embryo through a series of equilibration solutions or it sits for 10 to 15 minutes. After its collaborated, it goes into the actual vitrification solution where it sits for 30 seconds. From there. It goes into liquid nitrogen. It’s very important, the freezes down quickly and that the solutions used are as gentle to the embryo as possible. Prior to freezing the embryo, the embryologist will prepare the liquid nitrogen. You can see here, there is a cane which is the structure that holds the straw, the emerald in it. After the verification process is complete, the embryo is transferred into the liquid. Nitrogen to do the actual freeze. The straw is closed and placed into the cane. The cane has taken through into the storage room. Here in the tank room, we store all our human embryos in this room alone. There are more than 2000 embryos sitting within these tanks. What the embryologist is about to do is put the cane that holds the straw with the embryo into the storage tank. The liquid nitrogen tanks are at minus 196 degrees and that’s almost as cold as it’s possible to get at that temperature cells, eggs sperm, and embryos can survive almost forever. When the time comes
that a patient wants to use their frozen embryos, our scientists will warm the frozen embryo. You can see the embryologist here moving the embryo through a gradient of solutions, for a few minutes at a time giving the embryo, the right support to allow it to thaw and return to its old shape. Once the thor is complete, the embryo is ready to transfer, back to the patient. Now, we are ready to transfer the best embryo here. You can see the embryologist, loading, the embryo up into the catheter ready for replacement into the uterus. Once the doctor has prepared, the patient, the embryo will be transferred into the uterus under ultrasound guidance. Now after all that work, our patient faces her anxious too weak weight for the outcome of a pregnancy test. So there you have it, snapshot of what happens every day in our laboratories, the combination of expertise and skills of our embryologists, honed over many years of training and practice. With a very latest advances in digital technology. This allows us to keep your embryos safe and secure all the way through their journey as well as giving you the best chance of success.

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